Background: Pediatric patients with impaired immune systems, including those with chronic renal failure, should receive pneumococcal vaccinations which have a great role in prevention of chest infections. Objective: The aim of the current work was to evaluate immune response for Pneumococcal Conjugate Vaccine 13 (PCV13) in Hemodialysis (HD) children after 3 months 1 year and 2 years of vaccination. Patients and methods: Thirty-six children and adolescent on regular HD were included in this trial. All patients were not previously vaccinated by PCV13. We had determined pneumococcal immunoglobulin (IgG) antibodies 3 months, 1 year and 2 years after vaccination by PCV13. This study was carried out in Dialysis Nephrology Unit at Zagazig University Hospital of Children. Results: As regard frequency of chest infection after PCV13, there was a statistically significant decrease in frequency for patients who developed chest infections after PCV vaccinations from 75% to 16.7%. Chest infections and antibody titers were statistically linked at three months, one year, and two years. The best cutoff of serum antibody titer at 2 years≥0.03825 for prediction of absence of infection with area under curve 0.917, sensitivity 90%, specificity 83.3%, positive predictive value 96.4% and negative predictive value 62.5% and accuracy 91.7% (p < 0.05). Conclusion: It is possible for patients with end-stage renal disease (ESRD) and dialysis to produce enough antibodies against the PCV13 vaccine to reduce their risk of developing chest infections. Adequate protective concentration of antibody post PCV13 which is higher than 0.35ug/ml was maintained for most of cases at 1 year.